Provider Demographics
NPI:1316931942
Name:BAUER, WILLIAM R (MD, PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9708
Mailing Address - Country:US
Mailing Address - Phone:419-483-2403
Mailing Address - Fax:419-483-8418
Practice Address - Street 1:5433 STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9708
Practice Address - Country:US
Practice Address - Phone:419-483-2403
Practice Address - Fax:419-483-8418
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350303832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123324Medicaid
OH000000118256OtherANTHEM
OH7156412OtherAETNA
OH01905OtherPARAMOUNT
OH01905OtherPARAMOUNT
OHA71327Medicare UPIN